非小细胞肺癌适形放射治疗中急性放射性食管炎影响因素的研究

Clinical and dosimetric risk factors of acute radiation esophagitis in non-small cell lung cancer patients treated with three-dimensional conformal radiotherapy

目的探讨接受三维适形放疗（3D—CRT）的非小细胞肺癌（NSCLC）患者发生≥2级急性放射性食管炎（ARE）的影响因素。方法回顾102例接受3D—CRT的NSCLC患者的临床资料及三维计划资料，采用RTOG分级标准，评价患者自放疗开始3个月内≥2级的ARE。分析临床因素和三维计划的剂量体积参数。结果发生2级ARE19例，3级15例，未出现更严重的ARE。非同步化疗组多因素回归分析显示，食管％（OR=1．170，P〈0．05）为≥2级ARE发生的惟一影响因素，食管V55的ROC曲线下面积为0．870（95％CI：0．782～0．957，P〈0．05），界值为16．0。同步化疗组多因素回归分析显示，食管匕，（OR=1．125，P〈0．05）和同步化疗方案（OR=39．740，P〈0．05）是≥2级ARE发生的影响因素，食管V35的ROC曲线下面积为0．782（95％CI：0．636～0．927，P〈0．05），界值为23．75。长春瑞滨＋顺铂（NP）同步化疗方案的≥2级ARE发生率明显低于其他方案（33．3％：66．7％）。结论非同步化疗患者，食管虬，是≥2级ARE的影响因素。同步化疗患者，食管‰和同步化疗方案是≥2级ARE的影响因素。同步NP方案≥2级ARE发生率较低。

Objective To analyze the clinical and dosimetric risk factors for acute radiation esophagitis （ARE） in non-small cell lung cancer （NSCLC） patients treated with three-dimensional conformal radiotherapy （3D-CRT） , and to find significant risk factors for clinical therapy. Methods A total of 102 NSCLC patients treated with 3D-CRT were retrospectively analyzed. ARE was scored according to the Radiation Therapy Oneology Group （RTOG） criteria with grade 2 or worse. Patients were divided into non-concurrent chemoradiotherapy group and concurrent ehemoradiotherapy group. The clinical and dosimetric factors associated with grade 2 or worse ARE were analyzed using univariate logistic regression, multivariate logistic analysis and receiver operating characteristic （ROC） curve. Results There were no grade 4 or 5 ARE observed in the 102 patients. Nineteen developed grade 2, 15 developed grade 3. In nonconcurrent ehemoradiotherapy group, muhivariate analysis showed that Vss was the only risk factor of grade 2/3 ARE. For ROC curve analysis, the cut-off point of V55 was 16.0 while the area under ROC curve was 0. 870 （95 % CI： 0. 782 -0. 957, P 〈 0.05 ）. In concurrent chemoradiotherapy group, multivariate analysis showed that V35 and chemotherapy regimens during radiotherapy were risk factors of grade 2/3 ARE. The cut-off point of V35 was 23.75 while the area under ROC curve was 0. 782 （95% CI： 0. 636 -0. 927,P 〈 0. 05）. Vinorelbine and cisplatin regimen showed low incidence of ARE contrast with gemcitabine/ docetaxel and eisplatin regimens （33.3% and 66.7% ）. Conclusions Vs5 is the only statistically significant risk factor associated with grade 2 or worse ARE for patients who don＇t accepted concurrent chemotherapy. V35 and chemotherapy regimens during radiotherapy are statistically significant risk factors associated with grade 2 or worse ARE for patients who accept concurrent chemotherapy. Vinorelbine and eisplatin regimen during radiotherapy shows low incidence of ARE.